A. Latar Belakang
Sebelum Deklarasi Alma Ata tahun 1978 tentang Perawatan Kesehatan
Utama (PHC), Indonesia telah mengembangkan berbagai bentuk Puskesmas
di beberapa daerah. Berdasarkan penelitian pada tahun 1976 diketahui bahwa
200 masyarakat kegiatan kesehatan berbasis (CBHA) telah diterapkan dan
dilaksanakan dalam masyarakat.
Seiring waktu, Puskesmas telah berkembang pesat dalam berbagai
bentuk CBHA dan salah satu dari itu dicatat sebagai Posyandu (Pos
Pelayanan Terpadu). Aktivitas itu meliputi lima program utama, yaitu keluarga
perencanaan, kesehatan ibu dan anak, perbaikan gizi, imunisasi dan diare
pencegahan. Selain Posyandu, ada rumah sakit bersalin desa (VMH) yang
dikelola oleh bidan desa sebagai cara untuk membuat kesehatan ibu dan anak
dekat dengan masyarakat jasa
CBHA dapat tumbuh secara progresif karena didukung oleh pusat
kesehatan. Namun, CBHA pergi ke penurunan ketika krisis moneter pada
tahun 1997 meledak yang mengakibatkan multi-dimensi krisis. Krisis
menciptakan reformasi total dalam banyak aspek, termasuk di sektor
kesehatan. Meskipun penting, desentralisasi menguasai aspek yang paling
pembangunan, Termasuk sektor kesehatan. Ini telah benar-benar mengubah
model perencanaan, yang sebelumnya adalah sentralisasi menjadi tergantung
pada masing-masing kabupaten. Ini memiliki implikasi pada prioritas
pengaturan
masing-masing
kabupaten. Banyak
perhatian
lebih
pada
C. DEFINISI PHC
Primary Health Care ( PHC ) adalah pelayanan kesehatan pokok
yang berdasarkan kepada metode dan teknologi praktis, ilmiah dan sosial
yang dapat diterima secara umum baik oleh individu maupun keluarga dalam
masyarakat melalui partisipasi mereka sepenuhnya, serta dengan biaya
yang dapat terjangkau oleh masyarakat dan negara untuk memelihara setiap
tingkat perkembangan mereka dalam semangat untuk hidup mandiri (self
reliance) dan menentukan nasib sendiri (self determination).
D. PRINSIP PHC
Pada tahun 1978, dalam konferensi Alma Ata ditetapkan prinsipprinsip PHC sebagai pendekatan atau strategi global guna mencapai
kesehatan bagi semua. Lima prinsip PHC sebagai berikut :
a. Pemerataan upaya kesehatan
Distribusi perawatan kesehatan menurut prinsip ini yaitu perawatan
primer dan layanan lainnya untuk memenuhi masalah kesehatan utama
dalam masyarakat harus diberikan sama bagi semua individu tanpa
memandang jenis kelamin, usia, kasta, warna, lokasi perkotaan atau
pedesaan dan kelas sosial.
b. Penekanan pada upaya preventif
Upaya preventif adalah upaya kesehatan yang meliputi segala usaha,
pekerjaan dan kegiatan memelihara dan meningkatkan derajat kesehatan
dengan peran serta individu agar berprilaku sehat serta mencegah
berjangkitnya penyakit.
c. Penggunaan teknologi tepat guna dalam upaya kesehatan
Teknologi medis harus disediakan yang dapat diakses, terjangkau, layak
dan diterima budaya masyarakat (misalnya penggunaan kulkas untuk
vaksin cold storage).
d.
Peran serta masyarakat dalam semangat kemandirian
Peran serta atau partisipasi masyarakat untuk membuat penggunaan
maksimal dari lokal, nasional dan sumber daya yang tersedia lainnya.
Partisipasi masyarakat adalah proses di mana individu dan keluarga
bertanggung jawab atas kesehatan mereka sendiri dan orang-orang di
sekitar mereka dan mengembangkan kapasitas untuk berkontribusi dalam
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a. Pemeliharaan Kesehatan
b. Pencegahan Penyakit
c. Diagnosis dan Pengobatan
d. Pelayanan Tindak lanjut
e. Pemberian Sertifikat
H. ELEMEN-ELEMEN PHC
Dalam pelaksanaan PHC harus memiliki 8 elemen essensial yaitu :
a. Pendidikan mengenai masalah kesehatan dan cara pencegahan penyakit
b.
c.
d.
e.
f.
g.
h.
I.
J.
serta pengendaliannya
Peningkatan penyedediaan makanan dan perbaikan gizi
Penyediaan air bersih dan sanitasi dasar
Kesehatan Ibu dan Anak termasuk KB
Imunisasi terhadap penyakit-penyakit infeksi utama
Pencegahan dan pengendalian penyakit endemic setempat
Pengobatan penyakit umum dan ruda paksa
Penyediaan obat-obat essensial
CIRI-CIRI PHC
Adapun ciri-ciri PHC adalah sebagai berikut :
a. Pelayanan yang utama dan intim dengan masyarakat
b. Pelayanan yang menyeluruh
c. Pelayanan yang terorganisasi
d. Pelayanan yang mementingkan kesehatan individu maupun masyarakat
e. Pelayanan yang berkesinambungan
f. Pelayanan yang progresif
g. Pelayanan yang berorientasi kepada keluarga
h. Pelayanan yang tidak berpandangan kepada salah satu aspek saja
TANGGUNG JAWAB TENAGA KESEHATAN DALAM PHC
Tanggung jawab tenaga kesehatan dalam PHC lebih dititik beratkan
kepada hal-hal sebagai berikut :
a. Mendorong partisipasi aktif masyarakat dalam pengembangan dan
implementasi pelayanan kesehatan dan program pendidikan kesehatan
b. Kerjasama dengan masyarakat, keluarga, dan individu
c. Mengajarkan konsep kesehatan dasar dan teknik asuhan diri sendiri pada
masyarakat
d. Memberikan bimbingan dan dukungan kepada petugas pelayanan
kesehatan dan kepada masyarakat
e. Koordinasi kegiatan pengembangan kesehatan masyarakat.
DAFTAR PUSTAKA
http://www.searo.who.int/LinkFiles/Conference_INO-13-July.pdf
http://en.wikipedia.org/wiki/Primary_health_care
http://www.depkes.go.id/index.php/berita/press-release/1558-implementasiprimary-health-care-di-indonesia.html
http://www.scribd.com/doc/19834440/Primary-Health-Care
Lampiran
Declaration of Alma-Ata
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12
September
1978
The International Conference on Primary Health Care, meeting in Alma-Ata this
twelfth day of September in the year Nineteen hundred and seventy-eight,
xpressing the need for urgent action by all governments, all health and
development workers, and the world community to protect and promote the health
of all the people of the world, hereby makes the following
Declaration:
I
The Conference strongly reaffirms that health, which is a state of complete
physical, mental and social wellbeing, and not merely the absence of disease or
infirmity, is a fundamental human right and that the attainment of the highest
possible level of health is a most important world-wide social goal whose
realization requires the action of many other social and
economic sectors in addition to the health sector.
II
The existing gross inequality in the health status of the people particularly
between developed and developing countries as well as within countries is
politically, socially and economically unacceptable and is, therefore, of common
concern to all countries.
III
Economic and social development, based on a New International Economic Order,
is of basic importance to the fullest attainment of health for all and to the
reduction of the gap between the health status of the developing and developed
countries. The promotion and protection of the health of the people is essential to
sustained economic and social development and contributes to a better quality of
life and to world peace.
IV
The people have the right and duty to participate individually and collectively in
the planning and implementation of their health care.
V
Governments have a responsibility for the health of their people which can be
fulfilled only by the provision of adequate health and social measures. A main
social target of governments, international organizations and the whole world
community in the coming decades should be the attainment by all peoples of the
world by the year 2000 of a level of health that will permit them to lead a socially
and economically productive life. Primary health care is the key to attaining this
target as part of development in the spirit of social justice.
VI
Primary health care is essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at a
cost that the community and country can afford to maintain at every stage of their
development in the spirit of selfreliance and self-determination. It forms an
integral part both of the country's health system, of which it is the central function
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and main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family and
community with the national health system bringing health care as close as
possible to where people live and work, and constitutes the first element of a
continuing health care process.
VII
Primary health care:
1. reflects and evolves from the economic conditions and sociocultural and
political characteristics of the country and its communities and is based on the
application of the relevant results of social, biomedical and health services
research and public health experience;
2. addresses the main health problems in the community, providing promotive,
preventive, curative and rehabilitative services accordingly;
3. includes at least: education concerning prevailing health problems and the
methods of preventing and controlling them; promotion of food supply and proper
nutrition; an adequate supply of safe water and basic sanitation; maternal and
child health care, including family planning; immunization against the major
infectious diseases; prevention and control of locally endemic diseases;
appropriate treatment of common diseases and injuries; and provision of essential
drugs;
4. involves, in addition to the health sector, all related sectors and aspects of
national and community development, in particular agriculture, animal husbandry,
food, industry, education, housing, public works, communications and other
sectors; and demands the coordinated efforts of all those sectors;
5. requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of primary health
care, making fullest use of local, national and other available resources; and to this
end develops through appropriate education the ability of communities to
participate;
6. should be sustained by integrated, functional and mutually supportive referral
systems, leading to the progressive improvement of comprehensive health care for
all, and giving priority to those most in need;
7. relies, at local and referral levels, on health workers, including physicians,
nurses, midwives, auxiliaries and community workers as applicable, as well as
traditional practitioners as needed, suitably trained socially and technically to
work as a health team and to respond to the expressed health needs of the
community.
VIII
All governments should formulate national policies, strategies and plans of action
to launch and sustain primary health care as part of a comprehensive national
health system and in coordination with other sectors. To this end, it will be
necessary to exercise political will, to mobilize the country's resources and to use
available external resources rationally.
IX
All countries should cooperate in a spirit of partnership and service to ensure
primary health care for all people since the attainment of health by people in any
one country directly concerns and benefits every other country. In this context the
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joint WHO/UNICEF report on primary health care constitutes a solid basis for the
further development and operation of primary health care throughout the world.
X
An acceptable level of health for all the people of the world by the year 2000 can
be attained through a fuller and better use of the world's resources, a considerable
part of which is now spent on armaments and military conflicts. A genuine policy
of independence, peace, dtente and disarmament could and should release
additional resources that could well be devoted to peaceful aims and in particular
to the acceleration of social and economic development of which primary health
care, as an essential part, should be allotted its proper share. The International
Conference on Primary Health Care calls for urgent and effective national
and international action to develop and implement primary health care throughout
the world and particularly in developing countries in a spirit of technical
cooperation and in keeping with a New International Economic Order. It urges
governments, WHO and UNICEF, and other international organizations, as well as
multilateral and bilateral agencies, nongovernmental
organizations, funding agencies, all health workers and the whole world
community to support national and international commitment to primary health
care and to channel increased technical and financial support to it, particularly in
developing countries. The Conference calls on all the aforementioned to
collaborate in introducing, developing and maintaining primary health care in
accordance with the spirit and content of this Declaration.
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